Stress-reducing interventions in pregnancy for the prevention of preterm birth: a systematic review and meta-analysis

Figures & data

Figure 1. Flowchart of the included studies.

Table 1. Included studies on stress-reducing interventions during pregnancy.

Author, year	Study type	Country	Selection criteria	Type of intervention	Number of participants	Outcomes	Conclusion
Aktan, 2021 [18]	RCT	Turkey	Pregnant women ≤35 years old, without pregnancy complications	IG: Childbirth training with pilates CG 1: Childbirth training alone CG 2: Usual care	IG: 21 CG 1: 21 CG 2: 22 Total: 64	PTB, gestational age, birth weight, maternal anxiety (STAI)	IG less anxious, no sign differences in PTB, gestational age and birth weight
Bhartia, 2019 [19]	RCT	India	Low risk pregnant women between 18-20 weeks’ gestation	IG: Yoga trice a week for 12 weeks CG: Usual care	IG: 38 CG: 40 Total: 78	PTB, gestational age, birth weight, maternal stress (PSS)	IG less stress, no sign differences in PTB, gestational age and birth weight
Bolanthakodi, 2018 [20]	RCT (single blinded, parallel randomized)	India	Primigravid women, 20–35 years, after 30 weeks’ gestation, without pregnancy and medical complications	IG: Yoga 7 sessions and trice a week CG: Usual care	IG: 75 CG: 75 Total: 150	PTB, LBW	IG less LBW, no sign differences in PTB
Consonni, 2010 [21]	Non randomized controlled trial	Brazil	Pregnant primigravid low risk women between 18-20 weeks’ gestation	IG: Multidisciplinary Program (education, kinesiotherapy, and relaxation techniques CG: Usual care	IG: 38 CG: 29 Total: 67	PTB, LBW, maternal anxiety (STAI)	IG less anxious, no sign differences in PTB and LBW
Malhotra, 2021 [22]	Longitudinal (panel) study	India	All pregnant women	IG: Baby care program (mindfulness, yoga, music, baby bonding and education) CG: Usual care	IG: 255 CG: 257 Total: 512	PTB, gestational age, birth weight, LBW, maternal stress (PSRS)	IG less stress, higher gestational age and birth weight, less PTB and LBW
Narendran, 2005 [23]	Prospective observational study	India	Healthy pregnant women, 18-35 years old, between 18-20 weeks’ gestation	IG: Yoga daily CG: Usual care	IG: 169 CG: 166 Total: 335	PTB, gestational age, birth weight, LBW	IG less PTB and LBW. No sign differences in mean gestational age and birth weight
Pais, 2021 [24]	RCT	India	Healthy pregnant women, 20-35 years old, between 18-20 weeks’ gestation	IG: Yoga daily CG: Usual care	IG: 61 CG: 63 Total: 124	PTB, gestational age, birth weight	IG less PTB, higher gestational age and birth weight
Reinhard, 2009 [25]	Comparison with historical control group	Germany	All pregnant women, between 28-34 weeks’ gestation	IG: Hypnosis CG: Usual care	IG: 64 CG: 2.135 Total: 2.199	PTB	IG less PTB
Werner, 2013 [26]	RCT (single blinded)	Denmark	Nulliparous pregnant women with an uncomplicated pregnancy, >18 years old, between 27-30 weeks’ gestation	IG 1: Hypnosis IG 2: Relaxation CG: Usual care	IG 1: 493 IG 2: 494 CG: 230 Total: 1.217	PTB, birth weight	No sign differences
Yekefallah, 2021 [27]	Clinical trial study	Iran	Nulliparous pregnant women with an uncomplicated pregnancy, 18-35 years old, between 26-28 weeks’ gestation	IG: Yoga twice a week CG: Usual care	IG: 35 CG: 35 Total: 70	PTB, gestational age, birth weight	IG less PTB, higher gestational age and birth weight

CG, control group; IG, intervention group; LBW, low birth weight; PSRS, Perceived Stress Reactivity Scale; PSS, Perceived Stress Scale; PTB, preterm birth; RCT, randomized controlled trial; STAI, State-Trait Anxiety Inventory.

Figure 2. Forest plot analysis on stress-reducing interventions and preterm birth risk ratio.

Figure 3. Forest plot analysis on stress-reducing interventions and low birth weight risk ratio.

Figure 4. Funnel plot of the included studies.

Figure 5. Risk of bias summary.

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